The first step, breathe. DBT is an intensive therapy program for people struggling with emotion dysregulation, life-threatening behaviors, substance use, etc. So, while I know I don’t know your *exact* struggles, I can only imagine the stress you’re under in trying to help keep your teen safe while also managing other areas of life like family, work, and that never-ending to-do list. It is my hope to provide you with a list of things to do to help yourself and your teen in the immediate aftermath of this referral as well as some more long-term things to consider and look into as you and your teen prepare for treatment and while in treatment. I’m going to link several blogs that myself and my team have written over the years. This can be overwhelming, so feel free to just get the general idea from this page and revisit these blogs to get more information when you can.
Step 1: Slow down and take care of yourself first
Like I mentioned above, the first step has to be to take care of yourself. You just received this information and I bet your head is spinning trying to wrap your head around whatever it is that led to this referral and what next steps are. Take a few moments and slow down. Breathe. Your first instinct might be to go, go, go and, while I completely understand that, you’re going to need your thinking brain online (hopefully you’ll learn more about this at some point), in order to think through next steps. Here, get a jump start on some skills and read this blog on DBT skills to reduce stress, pick at least one skill and do it now.
Step 2: Educate yourself on DBT
Very briefly, DBT is an evidence-based treatment created by Dr. Marsha Linehan to help treat BPD, mood disorders, PTSD, substance use, and more. It has been proven to be effective in helping people decrease suicide and self-harm behaviors and other problem behaviors.
The comprehensive DBT program consists of 4 main pillars to help clients achieve these goals:
- Individual therapy
- Skills training group
- 24-hour phone coaching
- Team consultation for the clinician
These pillars help clients learn and generalize skills to their own lives to manage dysregulation and problem-behaviors. These skills are taught in four modules:
- Mindfulness
- Emotion Regulation
- Interpersonal Effectiveness
- Distress tolerance
This post gives a brief overview of the 4 pillars and the 4 skills modules: What Exactly is DBT?
While this is a similar post, this one reviews the importance of finding DBT-adherent programs, provides more information on the 4 pillars, and finally, gives you questions to ask as you are searching for a competent, adherent DBT provider: What is Comprehensive DBT?
Step 3: Check your insurance/financial situation
It would be silly for me to pretend like finances don’t play a major role in treatment. The comprehensive DBT program entails group and individual therapy and the cost of treatment can definitely add up. That being said, DBT has been shown to reduce hospitalizations due to mental health crises. This can actually cost less over time than repeated hospitalizations. Plus, we’re helping our clients build lives they find worth living!
At Cincinnati Center for DBT, we have clinicians that accept Aetna through a third-party company called Headway. Some of our clinicians also work with Lyra, an EAP program. Both of these can drastically reduce the cost of treatment.
If you do not have Aetna or work for a company that offers Lyra benefits, hope is not lost! Your insurance may reimburse some of the costs of treatment! We provide superbills (the paperwork insurance requires for reimbursement) automatically every month for you to submit to your insurance for reimbursement.
We are also newly rolling out a new service, Mentaya, that helps clients with out-of-network reimbursement, if you’re interested in pursuing this option. You can quickly check your insurance reimbursement for out-of-network providers and find answers to other questions in our FAQs.
You can also talk to your clinician about financial concerns you may have. They can help provide resources or help problem-solve with you as you discuss the best course of treatment for your teen.
Therapy is expensive and that’s not lost on us. We want to support you and your teen as much as we can throughout this time.
Step 4: Find a Competent, Adherent DBT Clinician
Now that you’ve explored your options financially, it’s time to find a competent clinician. Believe it or not, we have a blog on this too, Choosing a Competent Dialectical Behavior Therapist!
Essentially, that post speaks to the importance of finding a competent clinician. The DBT-Linehan Board of Certification has a list of certified DBT therapists. You can search through this site and find a clinician this way.
Now, you may not find a certified clinician in your area. The certification process is rigorous and there are plenty of competent clinicians who are not certified but do provide adherent DBT. Here at Cincinnati Center for DBT, we receive thorough and ongoing training in DBT. We are mentored by Dr. Nikki Winchester who has been certified by the Linehan Board and we all participate in weekly consultation. You can find a competent DBT clinician through CCDBT here.
If you cannot find a clinician through CCDBT that is available, fits your financial budget, or suits your needs, use the questions at the bottom of this blog (also linked above) as you’re calling around and speaking to other clinicians. We want to make sure you’re receiving adherent DBT, even if it’s not through us!
If you find a clinician you like outside of our organization, you can always join one of our skills training groups! We just require that clients that join our skills training groups are in individual therapy at least biweekly. Click here to learn more about our services and schedule an intake.
Step 5: Get your teen on board
This may be the toughest step. As mentioned several times now, DBT is an intensive therapy. It requires clients to engage in weekly therapy where they’ll be asked to do homework and discuss really challenging topics. They’ll also be asked to do a 2-hour weekly skills training group for 6 months. This can be a hard sell for many teens.
Talk to them about your concerns and why you think this is important. If I had to guess, by and large, the main reasons are: you love them, you want what’s best for them, AND you may not know how to help them with what they’re dealing with right now. Show them some of the resources you’ve found on DBT and give them an idea of what to expect (their therapist will do this too, but it might help to have them to know what they’re walking into ahead of time). Explore with your teen their goals for themselves, short-term and also long-term. Again, their therapist will do this with them too, but this can be a good activity to do together and can get some vital buy-in from your teen to even sign up and participate in the process.
Teens going through the comprehensive DBT program will be doing the skills training group with a parent. This is obviously a commitment for you or another adult in their lives. I know that our groups run from 6 p.m.-8 p.m.- it’s late and you’ve had a full day of work. You’re probably tired and want to be home unwinding from the day. That being said, if you’re dragging your feet, complaining about it loudly, etc. they’re likely to follow suit. Instead, lead by example. Talk about the things you might be excited to learn about, the goals you have for yourself, and your willingness to go through this process with them. It can really help your teen to know that you support them and that you’re going on this journey with them.
For yourself and your teen, remind yourselves that the group is a 24-week commitment and just about every client I’ve ever had go through group speaks to how fast it goes. It’s not a forever thing. In fact, one of the best parts of DBT is that it’s meant to end at some point. It’s designed so you learn skills, learn how to analyze your behavior, and then process and problem-solve so that you can do this on your own and you don’t need to go to therapy forever.
To answer some questions you may have on the format of the multifamily group and why it’s helpful, here’s a short clip of one of our clinicians, Dr. Desirae Allen, discussing this very topic, The Multifamily Group Format and Why It Is Helpful
Step 6: Sign up!
You can sign up for an intake online or reach out to our staff by clicking here. You can look through our clinicians’ bios and see who may be a good fit for your teen. I’d encourage you to involve your teen in this process as well! We also have TONS of resources on there. The blog section, where I linked many things throughout this article, also contains so many posts about DBT, what to expect, skills and how to use them, parenting resources, and so much more.
You and your teen have a long road ahead of you. I wish you all the best of luck and please reach out if you need any help in this process.
You can do it!
About the Author
Maria Mangione (she/her), M.A., LPCC is a licensed clinical counselor who specializes in dialectical behavior therapy. Maria works to help people develop the tools they need to develop trust in themselves and build their life worth living. Maria believes in having meaningful connections with her clients and believes that therapy and healing can be fun. Click Here to learn more about Maria’s experience and therapeutic style.